Du ZR, Yan CW, Chen ZJ, Zong L. Modified Kamikawa anastomosis after proximal gastrectomy: A narrative review. World J Gastrointest Surg 2026; 18(9): 121953 [DOI: 10.4240/wjgs.121953]
Corresponding Author of This Article
Liang Zong, MD, PhD, Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, No. 502 Changxing Road, Changzhi 046000, Shanxi Province, China. 250537471@qq.com
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Surgery
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review-article
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Du ZR, Yan CW, Chen ZJ, Zong L. Modified Kamikawa anastomosis after proximal gastrectomy: A narrative review. World J Gastrointest Surg 2026; 18(9): 121953 [DOI: 10.4240/wjgs.121953]
World J Gastrointest Surg. Sep 27, 2026; 18(9): 121953 Published online Sep 27, 2026. doi: 10.4240/wjgs.121953
Modified Kamikawa anastomosis after proximal gastrectomy: A narrative review
Zhuo-Ran Du, Cai-Wen Yan, Zhi-Jun Chen, Liang Zong
Zhuo-Ran Du, Liang Zong, Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China
Cai-Wen Yan, Department of Gastroenterology, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China
Zhi-Jun Chen, Department of Gastrointestinal Surgery, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
Co-corresponding authors: Zhi-Jun Chen and Liang Zong.
Author contributions: Du ZR, Chen ZJ, and Zong L conceived and designed the review; Du ZR and Yan CW performed the literature search and drafted the manuscript; Chen ZJ contributed to literature interpretation and technical discussion; Zong L critically revised the manuscript for important intellectual content; and all authors have read and approved the final manuscript. Chen ZJ and Zong L contributed equally to this manuscript and are co-corresponding authors.
AI contribution statement: The manuscript was totally drafted and completed manually by authors themselves. ChatGPT was only used for language polishing and formatting assistance. No AI tool was used to generate research data, select reference articles, interpret the study results, or formulate the scientific conclusions. All AI-assisted outputs were critically reviewed, revised, and approved by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Liang Zong, MD, PhD, Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, No. 502 Changxing Road, Changzhi 046000, Shanxi Province, China. 250537471@qq.com
Received: April 7, 2026 Revised: May 30, 2026 Accepted: July 1, 2026 Published online: September 27, 2026 Processing time: 163 Days and 3.2 Hours
Abstract
The Kamikawa anastomosis, also known as the double-flap technique, is a digestive tract reconstruction method designed to reduce gastroesophageal reflux and anastomotic complications after proximal gastrectomy. However, its technical complexity has limited its widespread adoption. In recent years, the modified Kamikawa anastomosis (MKA) has been introduced to simplify key steps of the original procedure while preserving its anti-reflux mechanism. Major modifications include the use of barbed continuous suturing, individualized flap widths, improved esophageal mobilization, and ultrasonic opening of the esophageal stump. Available evidence suggests low rates of reflux esophagitis, anastomotic leakage, and stenosis in carefully selected patients; however, most data are derived from single-center retrospective series with limited follow-up. Multicenter prospective studies and randomized trials are still needed to define optimal indications, validate functional benefits, and clarify long-term oncological safety. This minireview summarizes the technical modifications, perioperative safety, functional preservation outcomes, and postoperative complication management of MKA after proximal gastrectomy, based on recent literature and clinical experience. The clinical value and future prospects of MKA are also discussed, with an emphasis on its potential role in improving postoperative recovery and quality of life.
Core Tip: Modified Kamikawa anastomosis is a simplified form of the Kamikawa double-flap technique for digestive tract reconstruction after proximal gastrectomy. By preserving the anti-reflux valve mechanism while reducing technical complexity, the modified Kamikawa anastomosis can reduce reflux and anastomotic complications and improve postoperative recovery. This minireview summarizes current technical refinements, clinical indications, perioperative safety, functional outcomes, and remaining evidence gaps, emphasizing the need for multicenter prospective studies and longer oncological follow-up.
